RESUMO
Evidence-based practice is key to improving patient outcomes but can be challenging for busy nurse practitioners to implement. This article describes the process of critically appraising evidence for use in clinical practice and offers strategies for implementing evidence-based innovations and disseminating the findings.
Assuntos
Tomada de Decisões , Prática Clínica Baseada em Evidências/organização & administração , Profissionais de Enfermagem/psicologia , Humanos , Pesquisa Metodológica em EnfermagemRESUMO
PURPOSE: This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. METHODS: The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. RESULTS: There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. CONCLUSIONS: Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Educação em Saúde , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente/psicologia , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Cultura , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Dieta , Aconselhamento Diretivo/métodos , Estudos de Viabilidade , Comportamento Alimentar , Feminino , Hemoglobinas Glicadas/metabolismo , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Americanos Mexicanos/etnologia , Americanos Mexicanos/psicologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Seleção de Pacientes , Avaliação de Programas e Projetos de Saúde , Autocuidado , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Circunferência da Cintura , Redução de PesoRESUMO
PURPOSE: The purpose of this article is to describe methods used to recruit and retain high-risk, Spanish-speaking adults of Mexican origin in a randomized clinical trial that adapts Diabetes Prevention Program (DPP) content into a community-based, culturally tailored intervention. METHODS: Multiple passive and active recruitment strategies were analyzed for effectiveness in reaching the recruitment goal. Of 91 potential participants assessed for eligibility, 58 participated in the study, with 38 in the intervention and 20 in the attention control group. The American diabetes association risk assessment questionnaire, body mass index, and casual capillary blood glucose measures were used to determine eligibility. RESULTS: The recruitment goal of 50 individuals was met. Healthy living diabetes prevention presentations conducted at churches were the most successful recruiting strategy. The retention goal of 20 individuals was met for the intervention group. Weekly reminder calls were made by the promotora to each intervention participant, and homework assignments were successful in facilitating participant engagement. CONCLUSIONS: A community advisory board made significant and crucial contributions to the recruitment strategies and refinement of the intervention. RESULTS: support the feasibility of adapting the DPP into a community-based intervention for reaching adults of Mexican origin at high risk for developing diabetes.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/prevenção & controle , Hemoglobinas Glicadas/metabolismo , Americanos Mexicanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Cultura , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Avaliação de Programas e Projetos de Saúde , Autocuidado , Inquéritos e QuestionáriosRESUMO
PURPOSE: The purpose of this article is to report the results of a culturally tailored diabetes intervention for Mexican Americans on physical activity and to report the results of a focus group with intervention participants. DATA SOURCES: Seventeen Mexican American subjects with type 2 diabetes participated in the study. The study used a pretest/posttest control group design with 10 subjects in each group (N = 20). Outcome measures included the number of steps walked weekly, weight, and body mass index (BMI). Pedometers were used to measure the daily number of steps in the intervention group. A focus group provided data on participant satisfaction. CONCLUSIONS: Results suggest a positive effect of the intervention on physical activity level, weight, and sense of control over diabetes self-management. Intervention participants had a statistically significant increase in the number of steps walked per day and a statistically significant mean weight loss of five pounds. Focus group results indicate that participants were satisfied with the culturally tailored intervention and that they and their families benefited from the intervention. IMPLICATIONS FOR PRACTICE: A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.
Assuntos
Cultura , Diabetes Mellitus Tipo 2/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos , Educação de Pacientes como Assunto/métodos , Arizona , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Autocuidado , Inquéritos e Questionários , Resultado do Tratamento , CaminhadaRESUMO
PURPOSE: To explore the political and economic dimensions of diabetes self-management for Mexican American adults. DESIGN: Critical ethnographic analysis of focus group data from caregivers and adults with diabetes. FINDINGS: Three themes were identified: diabetes self-management is tied to other mental and bodily states, family and neighborhood environments cause stress and prevent diabetes solutions, and hassles of the health care environment subvert self-management. DISCUSSION: Cultural constructs about diabetes merge with social-political forces in explaining diabetes. IMPLICATIONS: Cultural competence in diabetes care requires attention to the political economy of the disease and advocacy for healthful political and economic change.
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Americanos Mexicanos/psicologia , Política , Pobreza , Autocuidado/psicologia , Valores Sociais , Adulto , Idoso , Antropologia Cultural , Cuidadores , Diabetes Mellitus Tipo 2/terapia , Feminino , Grupos Focais , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Modelos Psicológicos , Sudoeste dos Estados UnidosAssuntos
Diabetes Mellitus/epidemiologia , Profissionais de Enfermagem , Cultura , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Comportamentos Relacionados com a Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , México/epidemiologia , Obesidade/epidemiologia , Prevalência , Relações Profissional-Paciente , Autocuidado , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Translation of data collection instruments, paying careful attention to equivalency between the source and the target language, is important to obtain valid data collection instruments. OBJECTIVE: To translate the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English) into Spanish and to evaluate the reliability and validity of the Spanish version. METHODS: Translation and back-translation were used to develop the Spanish version of the SDSCA. The Spanish version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Psychometric properties were assessed further by combining data from three studies that used the Spanish version as a data collection instrument. RESULTS: Correlation of each item of the Spanish and English version of the SDSCA instrument ranged from .78 to 1.00, with no variability in the responses of 2 of the 12 items. Test-retest correlations for the SDSCA ranged from .51 to 1.00. Internal consistency (Cronbach's alpha) for the Spanish version was .68. Items loaded on three factors, with the factors accounting for 61% of the variance in SDSCA. DISCUSSION: The findings for the psychometric properties of the Spanish version of the SDSCA questionnaire suggest that it has conceptual and content equivalency with the original English version and is valid and reliable. However, further testing with larger samples is required.
Assuntos
Diabetes Mellitus/etnologia , Americanos Mexicanos , Autocuidado , Inquéritos e Questionários , Adulto , Idoso , Características Culturais , Diabetes Mellitus/terapia , Análise Fatorial , Feminino , Humanos , Idioma , Masculino , México/etnologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estados UnidosRESUMO
Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Promoção da Saúde/métodos , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Adulto , Idoso , Glicemia , Índice de Massa Corporal , Características Culturais , Estudos de Viabilidade , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-IdadeRESUMO
PURPOSE: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. METHODS: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. RESULTS: "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. CONCLUSIONS: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.